Basic Information
Provider Information
NPI: 1477780310
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PRICE
FirstName: EVAN
MiddleName: B
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2015 N MAIN ST
Address2:  
City: WHEATON
State: IL
PostalCode: 601873190
CountryCode: US
TelephoneNumber: 6306688250
FaxNumber: 6306689561
Practice Location
Address1: 2015 N MAIN ST
Address2:  
City: WHEATON
State: IL
PostalCode: 60187
CountryCode: US
TelephoneNumber: 6306688250
FaxNumber: 6306689561
Other Information
ProviderEnumerationDate: 06/18/2009
LastUpdateDate: 08/12/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207W00000X036.132447ILY Allopathic & Osteopathic PhysiciansOphthalmology 

No ID Information.


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